Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy

Y. Inamoto, M. Ito, R. Suzuki, T. Nishida, H. Iida, A. Kohno, M. Sawa, M. Murata, S. Nishiwaki, T. Oba, M. Yanada, T. Naoe, R. Ichihashi, M. Fujino, T. Yamaguchi, Y. Morishita, N. Hirabayashi, Y. Kodera, K. Miyamura

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55 Citations (Scopus)

Abstract

Intestinal transplant-associated microangiopathy (i-TAM) is an important complication after allogeneic hematopoietic SCT. From 1997 to 2006, 87 of 886 patients with diarrhea after transplantation received colonoscopic biopsy. i-TAM, GVHD and CMV colitis were diagnosed histopathologically. The median duration from transplantation to the onset of diarrhea was 32 days (range: 9-130 days) and that from the onset of diarrhea to biopsy was 12 days (range: 0-74 days). The median maximal amount of diarrhea was 2l/day (range: 130-5600ml/day). Histopathological diagnosis included i-TAM (n = 80), GVHD (n = 26), CMV colitis (n = 17) and nonspecific findings (n = 2) with overlapping. Among 80 patients with i-TAM, abdominal pain was a major symptom, and only 11 patients fulfilled the proposed criteria for systemic TAM. Non-relapse mortality (NRM) among patients without resolution of diarrhea was 72% and i-TAM comprised 57% of NRM. NRM was 25% among patients without intensified immunosuppression, but was 52, 79 and 100% among those with intensified immunosuppression before diarrhea, after diarrhea, and before and after diarrhea, respectively. In conclusion, i-TAM is a major complication presenting massive refractory diarrhea and abdominal pain, which causes NRM. Avoiding intensified immunosuppression that damages vascular endothelium until the resolution of i-TAM may improve transplant outcome.

Original languageEnglish
Pages (from-to)43-49
Number of pages7
JournalBone Marrow Transplantation
Volume44
Issue number1
DOIs
Publication statusPublished - 2009
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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